背景:QTc值的预测效用,通过各种校正公式计算急性心肌梗死(AMI)患者术后主要不良心脑血管事件(MACCE)的发生率,值得进一步探索。这项研究致力于确定围手术期AMI患者不同QTc值对MACCE发生的预测准确性。
方法:对三百十四个AMI患者进行回顾性队列研究,包括81例住院MACCE和233例对照,被组装,全面收集基线人口统计学和临床数据。QTc值采用Bazett的校正公式推导,Fridericia,霍奇斯,阿什曼,弗雷明汉,Schlamowitz,Dmitrienko,Rautaharju,还有Sarma.分析方法包括比较统计,Spearman相关分析,二元逻辑回归模型,接收机工作特性(ROC)曲线,和决策曲线分析(DCA)。
结果:与对照组相比,MACCE队列中的QTc值显著升高(P<0.05)。心率与QTc之间的Spearman相关性分析显示,Sarma公式(QTcBaz)呈适度正相关(ρ=0.46,P<0.001)。在多因素二元逻辑回归中,每个QTc变异都是MACCE的独立风险因素,Sarma公式得出的QTc(QTcSar)具有最高的危险比(OR=1.025)。ROC曲线分析确定了阈值为446ms的QTcSar具有优异的预测能力(AUC=0.734),灵敏度为60.5%,特异性为82.8%。DCA显示,在高风险阈值范围为0至0.66和0.71-0.96时,QTcSar的净收益为正,QTcBaz,在临床环境中普遍存在,在阈值延伸至0-0.99时显示出正的净收益。
结论:对于围手术期AMI患者,与替代的QT校正公式相比,QTcSar在监测QTc间隔方面更具优势,为后续MACCE事件提供增强的预测能力。
The predictive utility of
QTc values, calculated through various correction formulas for the incidence of postoperative major adverse cardiovascular and cerebrovascular events (MACCE) in patients experiencing acute myocardial infarction (AMI), warrants further exploration. This study endeavors to ascertain the predictive accuracy of disparate
QTc values for MACCE occurrences in patients with perioperative AMI.
A retrospective cohort of three hundred fourteen AMI patients, comprising 81 instances of in-hospital MACCE and 233 controls, was assembled, with comprehensive collection of baseline demographic and clinical data. QTc values were derived employing the correction formulas of Bazett, Fridericia, Hodges, Ashman, Framingham, Schlamowitz, Dmitrienko, Rautaharju, and Sarma. Analytical methods encompassed comparative statistics, Spearman correlation analysis, binary logistic regression models, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA).
QTc values were significantly elevated in the MACCE cohort compared to controls (P < 0.05). Spearman\'s correlation analysis between heart rate and
QTc revealed a modest positive correlation for the Sarma formula (QTcBaz) (ρ = 0.46, P < 0.001). Within the multifactorial binary logistic regression, each
QTc variant emerged as an independent risk factor for MACCE, with the Sarma formula-derived QTc (QTcSar) presenting the highest hazard ratio (OR = 1.025). ROC curve analysis identified QTcSar with a threshold of 446 ms as yielding the superior predictive capacity (AUC = 0.734), demonstrating a sensitivity of 60.5% and a specificity of 82.8%. DCA indicated positive net benefits for QTcSar at high-risk thresholds ranging from 0 to 0.66 and 0.71-0.96, with QTcBaz, prevalent in clinical settings, showing positive net benefits at thresholds extending to 0-0.99.
For perioperative AMI patients, QTcSar proves more advantageous in monitoring QTc intervals compared to alternative QT correction formulas, offering enhanced predictive prowess for subsequent MACCE incidents.